Are There Supplements That Help Treat POTS (Postural Orthostatic Tachycardia Syndrome)?

Answer:

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition in which the heart races when rising or even while standing still. Additional symptoms may include lightheadedness/feeling faint, palpitations, shaking, blurred vision, nausea, weakness, and fatigue upon standing.

Do any vitamins or supplements help?

There is little evidence that supplementation can reduce POTS symptoms in people who do not have a specific nutrient deficiency. However, there is some evidence that people with POTS may be prone to having deficiencies in certain vitamins and minerals. This may be more prevalent in people with significant gastrointestinal symptoms associated with POTS, possibly due to decreased motility in the digestive tract. Some experts recommend testing for and supplementing to correct such deficiencies, including those discussed below (Parrish, Pract Gastroenterol 2019).

Vitamin D

While some research suggests that low or deficient blood levels of vitamin D may be common in people with POTS (Ashangari, Circulation 2013), other studies have not found an increased incidence of vitamin D deficiency in people with POTS compared to the general population (Loavenbruck, Neurology 2016).

There do not appear to be randomized, placebo-controlled trials on the effects of vitamin D supplementation in people with POTS. There are, however, two case reports in which women with POTS, who had vitamin D levels in the lower end of adequate, appeared to benefit from supplementing with vitamin D. Blood levels of vitamin D were increased from 22 to 46 ng/mL in one case and from 25 to 42 ng/mL in the other) by taking a prescription form of the active hormone form of vitamin D (calcitriol). This was reported to decrease heart rate upon standing, and/or improve other symptoms such as gastrointestinal symptoms after eating, and fatigue (Chaudhari, BMJ Case Rep 2012; Eason, Front Neurol Conference Abstract 2019).

Vitamin D supplementation was also shown to improve certain symptoms in a small study among teenage girls (average age 16) with orthostatic intolerance (which can include POTS, although the study did not specify) and vitamin D levels averaging 22 ng/mL. Taking 2,000 to 5,000 IU of vitamin D daily for two months increased vitamin D levels to 41 ng/mL on average and increased the amount of time the girls could tolerate standing on head-up tilt by about 15 minutes. Heart rate variability when standing on tilt was also increased after vitamin D treatment, which suggests the body was under less stress. Baroreflex sensitivity, a measure of how well the heart rate adapts to changes in blood pressure, also improved after supplementation with vitamin D. However, the study did not include a control group, making the results less meaningful (Shaltout, Hypertension 2020).

Until more is known, it would seem prudent for people with POTS to get adequate intake of vitamin D, and consider taking a vitamin D supplement if blood levels are low. See How Much Vitamin D Do I need and How Much Is Too Much in our Vitamin D Supplements Review, as well as our Top Picks among vitamin D supplements.

Thiamin (Vitamin B-1)

A small study in Buffalo, New York found that 6% of people suffering from POTS (postural tachycardia syndrome — associated with headache and dizziness upon standing) were mildly deficient in thiamin. Supplementing with 100 mg of thiamin daily appeared to significantly improve all symptoms in only one of four such patients within two weeks, although this improvement persisted with continued supplementation. (Three of these patients were also deficient in vitamin D.) (Blitshteyn, Neuro Res 2017). See our Top Pick for thiamin in our B Vitamin Supplements Review, which provides the same dosage used in this study.

Vitamin B-12

Children with POTS may be more likely to have low blood levels of vitamin B-12 than children without this condition, according to a small study in Turkey that compared blood levels in 125 children (average age 11) with various orthostatic intolerance syndromes, including 35 children with POTS, with blood levels in healthy children without these conditions. The average blood level of B-12 in children with POTS was 313 pg/mL (which is on the lower end of normal) compared to 411 pg/mL in healthy children (Oner, Pediatrics 2014). However, there does not appear to be any research investigating the effects of correcting B-12 deficiency on symptoms in children or adults with POTS, or the effects of supplementation in people with POTS who do not have low or deficient levels. Nevertheless, it would seem prudent to get adequate intake of B-12 and to check blood levels of vitamin B-12 if experiencing symptoms of deficiency. Learn more about vitamin B-12 and see our Top Picks among B-12 supplements in our B Vitamin Supplements Review.

Iron

A small study in the U.S. found a higher prevalence of low iron storage (50% vs 14%), iron deficiency (25% of teenage girls vs. 9%, and 16% of teenage boys vs. 1%), and anemia (18 % of teenage girls vs. 1.5 %, and 43 % of teenage boys vs. 0.1 %) in children and adolescents (ages 12 to 18) with POTS compared to the prevalence of these conditions in the normal pediatric population (Jarjour, Clin Auton Res 2013). There does not appear to be research on the effects of correcting iron deficiency or iron supplementation in children, adolescents or adults with POTS, however, since iron deficiency, like POTS, can cause symptoms such as weakness and fatigue, and may cause irregular heartbeats (arrythmias), it would seem wise to get adequate intakes and get blood levels checked if deficiency is suspected. Learn more about iron and see our Top Picks among iron supplements in our Iron Supplements Review.

Lifestyle approaches to treating POTS

Treatment of POTS generally includes lifestyle interventions such as increasing daily water intake (3 liters, i.e., 12 8 oz. glasses per day) and salt intake (5 to 10 grams of sodium per day), as this can increase blood volume. For example, in a study among adults with POTS, consuming a high-sodium diet (about 17 grams of sodium per day) increased plasma volume, and lowered blood levels of norepinephrine while standing, and led to smaller increases in heart rate while upright and upon standing from a supine position compared to a low-sodium diet (about 0.6 grams per day) (Garland, J Am Coll Cardiol 2021).

Other recommendations include engaging in regular exercise that can be performed without standing, such as using a recumbent bike, rowing machine, or swimming, keeping the head elevated during sleep, and avoiding large, heavy meals, alcohol, and prolonged exposure to heat (such as taking long, hot showers). Compression stockings that extend to the top of the thigh and/or abdominal binders, may also be helpful (Bryarly, J Am Coll Cardiol 2019).

When needed, medications such as propranolol (a beta-blocker that can slow heart rate), or other drugs such as midodrine, fludrocortisone, or pyridostigmine may be prescribed, although some of these medications may have adverse effects or worsen symptoms in some people. For example, propranolol may lower blood pressure too much and increase the risk of fainting.