Understanding POTS: Symptoms, Causes, and Why Hydration and Electrolytes Are Essential for Managing POTS

Heart Month Perspective: Understanding POTS and the Power of Hydration

February is Heart Month, a time when we traditionally focus on coronary artery disease, cholesterol, and blood pressure. Yet not all cardiovascular conditions stem from blocked arteries or structural heart problems. Some arise from dysfunction in how the heart and blood vessels regulate circulation. One of the most misunderstood of these is Postural Orthostatic Tachycardia Syndrome, commonly known as POTS.

As a cardiologist, I frequently meet patients who have spent months, sometimes years, searching for answers. They are often told their heart is “normal.” Structurally, it usually is. But functionally, the cardiovascular system is not behaving as it should.

What Is POTS?

POTS is a form of autonomic dysfunction that affects the regulation of heart rate and blood vessel tone. The autonomic nervous system controls involuntary processes such as heart rate, blood pressure, and vascular constriction. In healthy individuals, when you stand up, gravity pulls blood toward the lower body. The blood vessels constrict and the heart rate rises slightly to maintain steady blood flow to the brain.

In POTS, this compensation is exaggerated or insufficiently coordinated. By definition, there is an increase in heart rate of at least 30 beats per minute within 10 minutes of standing, without a significant drop in blood pressure. In adolescents, the threshold is 40 beats per minute.

The issue is not a primary heart muscle disease. It is a disorder of regulation. The heart and blood vessels are structurally intact, but the signaling between the nervous system and the cardiovascular system is disrupted.

How POTS Can Make You Feel

The symptoms can be profound and often debilitating.

Patients commonly describe:

• Rapid heart rate upon standing

• Lightheadedness or near-fainting

• Fatigue that feels disproportionate to activity

• Brain fog or difficulty concentrating

• Palpitations

• Shortness of breath

• Exercise intolerance

• Gastrointestinal discomfort

For many, simply standing in line or taking a hot shower can provoke symptoms. Some experience chest discomfort or tremulousness. Others report that their legs feel heavy or weak, reflecting blood pooling in the lower extremities.

It is important to understand that these symptoms are real and physiologically driven. They are not anxiety disorders, though anxiety can coexist. The elevated heart rate is a compensatory mechanism attempting to maintain adequate cerebral perfusion.

POTS can occur after viral illnesses, during periods of rapid growth in adolescence, or in association with autoimmune conditions. In recent years, we have seen increased recognition of POTS following viral infections.

Why Hydration Matters

One of the core physiological problems in POTS is relative hypovolemia, meaning reduced effective circulating blood volume. When there is insufficient blood volume, the body compensates by increasing heart rate. If the vascular tone is also impaired, blood pools in the lower body, further reducing blood return to the heart.

Increasing intravascular volume is therefore a cornerstone of therapy.

Clinical guidelines and expert consensus commonly recommend:

• Increasing daily fluid intake to approximately 2 to 3 liters

• Increasing sodium intake, often to 3,000 to 10,000 mg per day depending on individual tolerance and physician guidance

• Avoiding dehydration triggers such as prolonged heat exposure

The goal is to expand plasma volume. When blood volume improves, the heart does not need to race as aggressively to maintain circulation to the brain.

However, not all fluids are equally effective. Plain water hydrates, but without sufficient electrolytes, particularly sodium, much of it may not remain intravascular. Sodium helps retain water in the bloodstream and supports vascular tone.

Electrolytes such as sodium, potassium, and magnesium play essential roles in cellular function, nerve signaling, and muscle contraction. Inadequate electrolyte balance can worsen symptoms such as fatigue, dizziness, and palpitations.

Comprehensive Treatment Approach

Hydration is foundational, but it is not the only strategy.

Other commonly recommended interventions include:

• Compression garments to reduce blood pooling

• Gradual, structured exercise programs emphasizing recumbent or semi-recumbent training initially

• Avoiding prolonged standing

• Small, frequent meals to reduce postprandial blood pooling

• In selected cases, medications that support vascular tone or heart rate control

Exercise deserves particular emphasis. Deconditioning can worsen POTS symptoms. Carefully supervised cardiovascular conditioning improves autonomic balance and increases plasma volume over time.

That said, hydration and electrolyte optimization are typically the first and most accessible interventions.

Choosing the Right Hydration Strategy

For patients with POTS, the quality of hydration matters. Beverages high in sugar can cause rapid glucose spikes followed by reactive drops, potentially exacerbating fatigue and symptoms. Artificial additives may not be necessary and can be poorly tolerated by some individuals.

An effective hydration strategy should include:

• Adequate sodium content

• Balanced electrolytes

• Minimal added sugars

• Clean, transparent ingredients

This is where thoughtfully formulated electrolyte solutions can play a role.

Why Clean Formulations Matter

As a physician, I emphasize ingredient transparency. Patients managing chronic cardiovascular dysregulation should know exactly what they are consuming daily.

A hydration solution that prioritizes clean ingredients without unnecessary artificial dyes, preservatives, or excessive sugars aligns with modern evidence-based nutrition principles. Consistency is also critical. Hydration for POTS is not a one-time intervention. It is a daily strategy.

Products such as Enact Hydration are designed around these principles. With a focus on purity, balanced electrolytes, and clean formulation, it provides a practical way to support daily fluid and sodium goals without the drawbacks of heavily sweetened sports drinks.

For patients who struggle to meet sodium targets through food alone, incorporating a clean electrolyte solution into the daily routine can make adherence more realistic. The key is not branding alone, but formulation quality and consistency.

When recommending hydration support, I encourage patients to look for:

• Meaningful sodium content

• Absence of excessive sugar

• Transparent labeling

• Clean, simple ingredients

A daily hydration routine built around these criteria supports the physiological goals we are trying to achieve in POTS management.

A Heart Month Reminder

During Heart Month, it is important to remember that cardiovascular health is not limited to cholesterol numbers and angiograms. The heart is part of an integrated system that depends on proper regulation, volume status, and autonomic balance.

POTS reminds us that even when the heart muscle itself is normal, patients can experience life-altering symptoms due to dysregulation of circulation.

The encouraging reality is that many patients improve significantly with structured lifestyle measures. Adequate hydration and electrolyte balance are among the most powerful, evidence-supported tools we have.

If you or someone you know experiences unexplained tachycardia, dizziness upon standing, or persistent fatigue, evaluation by a knowledgeable clinician is important. Diagnosis can often be made with a careful history and orthostatic vitals.

With appropriate treatment, including a disciplined hydration strategy supported by clean electrolyte supplementation, many individuals with POTS regain stability, resilience, and quality of life.

The heart does not function in isolation. It responds to volume, tone, and regulation. Supporting those systems every day, especially through intentional hydration, is one of the simplest and most impactful steps we can take.